MEMBERSHIP APPLICATION FORM

If you would like to become a member of the

Gisborne & Mount Macedon Districts Historical Society


Print this form & mail with a cheque for
$20.00 single or $30.00 per couple to: 

Gisborne & Mount Macedon Districts Historical Society Inc., 

4 Hamilton Street, Gisborne, Victoria 3437

Or pay by direct deposit to Westpac Bank BSB 033 624 Account Number 41 24 77 

and advise by email to history@gisbornemountmacedon.org.au that a payment has been made and the  reference you have used.  
 

GISBORNE & MT. MACEDON DISTRICTS HISTORICAL SOCIETY INC.
ABN 82 893 878 458 Inc. No. A 0027147L

 

I/We:
ADDRESS:
PHONE: POSTCODE:
*E-MAIL: *WEBSITE:
desire to become a Full Member of the

GISBORNE & MOUNT MACEDON DISTRICTS HISTORICAL SOCIETY INC.
ABN 82 893 878 458 Inc. No. A 0027147L
If accepted as a Member, I/we agree to be bound by the rules of the Society.
 
NAME OF THE APPLICANT:
SIGNATURE OF THE APPLICANT:

 

DATE: